HISTORY: During a race, a 35-year-old marathon runner complained of experiencing dull, achy pain in the right groin. After the race, he occasionally experienced radiating pain in the right thigh. The athlete was examined by a general practitioner (GP). During the clinical evaluation, the athlete had no signs of tenderness or swelling. The GP suggested rest and prescribed anti-inflammatory medication.

PHYSICAL EXAMINATION: Ten days later, during training, the athlete felt the same discomfort after a challenging training session. He, then, decided to see an orthopedic physician. At the clinical examination, there was no localized pain. Focal pain was present during weight bearing activities only. Initial x-rays showed no significant abnormality or fracture. However, due to the complaints of the athlete, the doctor suggested additional x-rays and an MRI.


  1. Lumbar radiculopathy
  2. Rectus femoris strain
  3. Abductor strain
  4. Trochanteric bursitis


- X-ray showed a fracture of the middle shaft of the femur

- MRI showed a medial periosteal reaction in the femoral shaft (high fluid signal)

- Pain, especially during internal rotation

- Pain on the affected side with a single-leg stance

- Pain during activity, reproducible on passive range of motion


Stress fracture of the middle shaft of the right femur


  1. Tolerate weight bearing if no displacement occurs (four months max.)
  2. Treatment by a metabolic physician (Vitamin D deficiency or other)
  3. Continuing follow-up with repeated imaging: Verify resolution and minimize the progression to displacement
  4. Surgery if conservative management fails (see #1-3)
  5. Intramedullary rodding (surgical procedure)



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